Most physicians, public health officials and economists believe that most individuals do not receive sufficient levels of preventive care. Only half of American adults receive all recommended screening and preventive care.
The Partnership for Prevention has a plan to increase preventive care utilization. The organization proposes introducing:
“..federally funded insurance programs [that] would provide highly cost-effective clinical preventive services with no deductibles or co-pays, while Congress would provide incentives to states, health care providers and employers to deliver such services. Meanwhile, a stand-alone revenue source would be established to fund state and local efforts to create healthy environments and promote healthy lifestyles, while a Public Health Advisory Commission would be created to recommend how that funding should be allocated.”
Is this a good idea? There are benefits to this plan. Individuals without health insurance would have access to some of these preventive measures. The Vaccines for Children (VFC) program currently provides free vaccines to poor children, and this program has generally been seen as a success.
Overall, however, I do not endorse this plan. Here is why:
- Cost effectiveness: The idea is being presented as a cost saving initiative. While effective preventive care can increase longevity and improve the quality of life, it often increases health care costs.
- Carve-out problem. Enacting a universal, government provided health care system may be a good or bad thing depending out your point of view. However, a limited, carve-out program for preventive care will be…well…limited. Let us say the prevention health plan covers mammograms. If an uninsured individual receives a mammogram using the proposed program and finds a cancerous tumor what is the next step? The prevention health program will not cover surgery so the uninsured individual will be left with bad news and, if they are poor, few options to treat the disease. This will lead to…
- Coverage creep. In the example above, I anticipate an outcry for individuals from uninsured individuals who have breast cancer. They will lead to an expansion of coverage to treatments that are less-cost effective. Physicians will lobby to have certain treatments included in this national prevention health plan. Thus, what may start out as a health plan which only targets cost-effective treatments, will likely expand into other areas. For instance, the $700 billion bailout was targeted for financial firms only. Unsurprisingly, politically powerful sectors (e.g., the auto industry) have been lobbying for their share of the pie.
- Cost shifting. Private insurance companies who currently offer preventive services will not be able to shift their costs to the public sector. A profit-maximizing strategy is to shift as much cost to the public sector as possible. Thus, insurance companies will try to categorize as much medical as possible under a “prevention-eligible” diagnostic code.
- Paternalism. The plan will also pay for health care targeted to reduce tobacco and alcohol use, improve the patient’s diet and increase the patient’s physical inactivity. Most people know that using less drugs, exercising more and eating less will improve longevity. I personally do not think that it is the government’s job to tell you how to live your life. If you want a shorter life filled with more cheesecake, that should be left up to the individual.